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Estimate Number: 3 <br />Project Number: 21-02 <br />Pay Estimate Summary Sheet <br />Partial <br />Project Name: Tiger Street Reconstruction <br />Period Ending October 31, 2021 <br />Contractor: North Valley, Inc. <br />Address: 20015 Iguana Street NW, Suite 100 Nowthen, MN 55330 <br />1 Original Contract Amount $ 224,552.19 <br />2 Change Order(s) No. 1 Thru No. 1 $ 41,039.00 <br />3 Total Funds Encumbered $ 265,591.19 <br />4 Value of Work Completed $ 253,902.26 <br />Value of Work Remaining $ 11,688.93 <br />Percent Complete 96% <br />5 Retainage 5 % $ 12,695.11 <br />6 Previous Payment(s) $ 239,683.14 <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) $ 252,378.25 <br />Payment Due (Lines 4-8) <br />$ 1,524.01 <br />r <br />Certification of Partial Payment <br />I hereby certify that, to the best of my knowledge and belief, all Items, quantities and prices of work and material shown on <br />this Estimate are correct and that all work has been performed in full accordance with the terms and conditions of the <br />Contract for this project between owner and the undersigned Contractor, and as amended by any authorized changes and <br />the foregoing is a true and correct statement of the contract amount for the period covered by this estimate. <br />No9:14-\AaLAr, av\e L5(.1 kT-1,\.oey-y) <br />Contractor Name <br />Ck-r-4\Ce_ <br />Title <br />Print Name <br />Signature <br />t 1 Z`J (6)Q. <br />Date <br />City of Ramsey Approval <br />Signature (Project Engineer) <br />Signature (City Engineer) <br />Date <br />Date <br />Pay Estimate Page l of 2 <br />